Clarification (published Nov. 13, 2009): This story originally stated that Rep. Pete Sessions defended insurance-company practices that charge women higher premiums. The congressman's staff denies this, saying he actually was making a rhetorical point about why some groups pay more for insurance than others.

When health-care reform passed the House by just two votes late Saturday night, I assumed Speaker Nancy Pelosi had several more votes in her pocket from Blue Dogs who would be there if she needed them. After all, that's how Washington works. I also figured I shouldn't get too worked up about the restrictive amendment on abortion that was added at the last minute because it would be stripped from the legislation when it went to conference and was merged with the Senate bill. (Click here to follow Eleanor Clift).

It took just a little reporting for me to discover how wrong my initial assessments were. Even though the Democrats control the House by a substantial margin, Pelosi had no cushion with 40 conservative Blue Dogs threatening to bolt over taxes and abortion, and a quarter of House Democrats self-identifying as strongly pro-life. Given these political hurdles, ditching the amendment advanced by pro-life Michigan Democrat Bart Stupak is unlikely. (Article continued below...)

The best the pro-choice community can hope for is compromise language that doesn't go as far as the Stupak-Pitts amendment. The prospect of a Democratic Congress curtailing reproductive rights as a price for health-care reform is yet another reality check for those of us who thought Democratic control of Congress and the White House heralded a new day for progressive policies. "We have won the battle for women on right-to-choose in the courts," Democratic Congressional Campaign Committee Chair Chris Van Holland told NEWSWEEK. "We've never won this in Congress. It's a mistake to say that now Democrats are in charge, it's different. If we ever had a vote up or down on Roe v. Wade, my best guess is that it might be defeated."

The Democratic leadership worked hard to avoid the result they got. A proposal offered by Indiana Democrat Brad Ellsworth to segregate private dollars from public dollars to assure no federal money would go toward abortion satisfied pro-choice members but failed to attract enough pro-life votes. Pelosi, a practicing Catholic, has withstood verbal condemnation for her views from Catholic bishops throughout her political career, but meeting with them in her office at the Capitol on Saturday, they had the votes, and she didn't.

Pelosi had no choice, and to her credit, she understood that. Rep. Louise Slaughter, a New York Democrat and an Episcopalian, voiced outrage that the bishops could lobby so blatantly when their tax-exempt status should prevent such strong-arming, but those niceties were irrelevant with a make-or-break vote looming for health care. Democrats were surprised to learn that the health insurance provided to federal employees does not carry abortion coverage, weakening their argument that making it available in the new insurance exchanges would simply maintain the status quo.

Pro-choice activists are furious, and they're raising money from likeminded women who feel that their party has turned on them. The irony is that the amendment to ban abortion coverage passed handily with pro-choice Republicans such as Illinois Rep. Mark Kirk joining pro-life members in casting a hearty aye. Kirk is facing a primary for the U.S. Senate in Illinois, and the vote provides cover for him on the right. Without casting aspersions on strongly held beliefs on one side or the other, hot-button social issues like abortion say more about the way Congress works, and where members get their money, than it does about the views of the voters. Abortion is a difficult moral issue, but most Americans are reconciled to its legality and availability in the first trimester of pregnancy, and after that with restrictions that vary from state to state. Women without health insurance are not looking to Congress foremost to guarantee them abortion services; they want preventive health care and prenatal coverage.

Democrats didn't fare well this past week when it came to female-friendly policies, but Republicans looked even worse. Georgia Rep. Tom Price, an orthopedic surgeon, repeatedly shouted down Democratic Rep. Lois Capps as she debated on the House floor for full reproductive coverage for women. In response to Democratic Rep. Frank Pallone demanding to know why it is OK for companies to charge women more than men for insurance, Republican Rep. Pete Sessions noted, "We're all different. Why should a smoker pay more than a non-smoker?" Sessions's obvious implication is that it's OK to charge women more since their particular health needs pose a greater risk for insurance companies.

Republican right-wing ideology has little appeal to women, and throwing Dede Scozzafava under the bus in that upstate New York congressional race compounds the party's problem. "It's an accomplishment to lose a district held since Lincoln," says Morris Fiorina, a professor of political science at Stanford. "You can't just write that off and say it's a fluke." Fiorina was in Washington to promote his new book, Disconnect, about how little interest people have in politics, and how politicians obsess over hot-button issues that help them raise money from activists at the expense of issues that matter more to the public.

Voters on both sides of the abortion divide are more ambivalent in their views than the activists who profess to represent them. With both parties guilty of voter malpractice, the result is widespread anti-incumbent sentiment. Two thirds of Americans in the latest Pew Research survey say they are dissatisfied with the course of the country. They will be even more unhappy if health-care reform is taken hostage by abortion activists.

Eleanor Clift is also the author of Two Weeks of Life: A Memoir of Love, Death, and Politics and Woman, Child for Sale: The New Slave Trade in the 21st Century .

© 2009